BACKGROUND: For patients with nonmetastatic renal cell carcinoma (nmRCC) treated with nephrectomy, prediction of cancer-specific mortality (CSM) by T stage and substage has not been validated for the separate histological subtypes. OBJECTIVE: To investigate the ability of pathological T stage and substage to predict CSM for patients with clear-cell, papillary, or chromophobe nmRCC treated with nephrectomy. DESIGN, SETTING, AND PARTICIPANTS: Using the SEER database for 2004-2016, we identified 87 149 patients with T1-4 N0/X M0 nmRCC treated with nephrectomy for the clear-cell (65 715; 75.4%), papillary (14 587; 16.7%), or chromophobe (6847; 7.9%) histological subtype. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Kaplan-Meier plots and Cox regression models were used to estimate CSM. RESULTS AND LIMITATIONS: For all three histological subtypes, patients with T1a-T3a disease exhibited more favorable CSM than patients with T3b-T4 RCC. For clear-cell RCC, there were clinically meaningful and statistically significant differences for virtually all intergroup comparisons among T1a-T3a stages. For papillary T1a-T3a RCC, clinically meaningful differences disappeared, although the statistical significance remained. For chromophobe T1a-T3a RCC, no clinically meaningful or statistically significant differences were observed. For all three histological subtypes, patients with T3b-T4 RCC exhibited virtually uniformly unfavorable CSM, with no clinically meaningful intergroup CSM differences. CONCLUSION: The use of T stage and substage for stratification of patients with nmRCC treated with nephrectomy revealed differences in CSM among T1a-T3a cases, but not T3b-T4. The magnitude of the CSM difference was greatest for clear-cell, intermediate for papillary, and marginal for chromophobe RCC. PATIENT SUMMARY: For patients with kidney cancer, the stage of their disease assessed after surgery on the affected kidney can predict how likely they are to die from their cancer. This prediction varies for different subtypes of kidney cancer.

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Canada

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Canada; Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Canada; Department of Urology University of Naples Federico 2 Naples Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Canada; Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Cancer Prognostics and Health Outcomes Unit Division of Urology University of Montreal Health Center Montreal Canada; Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria; Departments of Urology Weill Cornell Medical College New York NY USA; Department of Urology University of Texas Southwestern Dallas TX USA; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia; Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Department of Urology University Hospital Frankfurt Frankfurt am Main Germany

Department of Urology University of Naples Federico 2 Naples Italy

Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Division of Urology Department of Surgery Juravinski Cancer Centre McMaster University Hamilton Canada

Martini Klinik Prostate Cancer Center University Hospital Hamburg Eppendorf Hamburg Germany

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